Provider Demographics
NPI:1952420168
Name:BORG, ELIZABETH W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:W
Last Name:BORG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6426 KINGS MILL CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5480
Mailing Address - Country:US
Mailing Address - Phone:734-453-2207
Mailing Address - Fax:734-453-8415
Practice Address - Street 1:580 FOREST AVE STE 1B
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1780
Practice Address - Country:US
Practice Address - Phone:734-453-2207
Practice Address - Fax:734-453-8415
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301008127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N20500Medicare PIN